目的 探讨超声引导交感神经阻滞联合中医药治疗难治性心绞痛的临床疗效.方法 收集2015年10月至2017年1月来诊的难治性心绞痛患者60例,随机分为研究组和对照组,每组30例.研究组给予超声引导交感神经阻滞麻醉联合中医药治疗,对照组采用常规盲探下交感神经阻滞麻醉联合中医药治疗,观察2组患者临床疗效、记录试验期间心绞痛的发作情况及治疗前后心绞痛发作次数及持续时间,并检测治疗前后血流动力学指标和心肌酶谱水平变化差异.结果 研究组心绞痛治疗显效率、总有效率分别为76.67％、93.33％,明显高于对照组的40.00％、73.33％,差异有统计学意义(P<0.05);2组患者治疗后心绞痛发作次数及持续时间计分较治疗前明显降低,且研究组发作次数及持续时间计分明显低于对照组,差异有统计学意义(P<0.05);全血粘度高切粘度、全血粘度低切粘度、纤维蛋白原、血浆粘度等血流动力学指标和cTnI、LDH、CK-MB等心肌酶谱指标均优于对照组,差异均有统计学意义(P<0.05).结论 超声引导神经阻滞麻醉联合中医药可有效治疗难治性心绞痛,其血流动力学及心肌酶谱指标均有显著改善,值得临床广泛应用.%Objective To investigate the clinical curative effects of ultrasound-guided sympathetic nerve block combined with traditional Chinese medicine on refractory angina pectoris. Methods Sixty patients with refractory angina pectoris who were diagnosed and treated in our hospital from October 2015 to January 2017 were randomly divided into research group ( n =30 ) and control group ( n =30 ) . The patients in research group were treated by ultrasound-guided sympathetic nerve block combined with traditional Chinese medicine,however, the patients in control group were treated by conventional blind sympathetic nerve block anesthesia combined with traditional Chinese medicine. After treatment, the therapeutic effects were evaluated. Moreover, the attack frequency and duration of angina pectoris before and after treatment were recorded. In addition, the changes of hemodynamic indexes and myocardial enzyme levels were observed and compared between two groups. Results The efficient rate ( 76. 67％) and total effective rate in research group were 76. 67％, 93.33％,respetively,which were significantly higher than those (40. 00％,73. 33％,respectively) in control group (P <0. 05). After treatment the attack frequency and duration of angina pectoris were significantly decreased in both groups, moreover, which in research group were significantly lower than those in control group (P < 0. 05). In addition, the hemodynamic indexes including blood viscosity high shear viscosity, low shear viscosity of whole blood viscosity, fibrinogen and plasma viscosity as well as myocardial enzyme indexes including cTnI, LDH, CK-MB in research group were superior to those in control group (P <0. 05). Conclusion The ultrasound-guided sympathetic nerve block combined with traditional Chinese medicine can obtain satisfactory therapeutic effects on refractory angina pectoris, which can improve the attack frequency and duration of angina pectoris, and improve the indexes of hemodynamics and myocardial enzyme,therefor, which is worth using widely in clinical practice.
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